Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Awareness, treatment and control of hypertension: the ‘rule of halves’ in an era of risk-based treatment of hypertension

A Corrigendum to this article was published on 18 January 2007

Abstract

Detection, treatment and control of high blood pressure in many populations are insufficient. We reported current prevalence, awareness, treatment and control of hypertension in the Netherlands and compared the findings with other studies. Furthermore, we related actual treatment of hypertension to estimated absolute 10-year cardiovascular risk, as according to current guidelines on this subject, initiation of blood pressure-lowering treatment depends on the level of cardiovascular risk. The Utrecht Health Project is a prospective cohort study in a suburb of Utrecht. Information on medical history, life style and measurements of blood pressure, cholesterol and glucose of the first 4950 participants of the study was obtained. Cardiovascular risks were calculated using the Framingham risk function. Prevalence of hypertension was 23.3%. Among those with hypertension, 33.7% was aware of the condition. Of those aware, 59.4% was treated. Of those treated, 41.9% had blood pressure below the recommended level. In half of those aware of their hypertension, and a calculated cardiovascular risk less than 10%, treatment of hypertension was started unnecessary. Of those aware of their hypertension with a calculated cardiovascular 10 years risk exceeding the treatment threshold of 20%, treatment was absent in 33.6%. Awareness and control of hypertension are still inadequate in the Netherlands and comparable with other European countries. Management of hypertension is too often not risk-based despite recommendations in guidelines on prevention of cardiovascular diseases available since 2000.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Fagard RH, Van Den EM, Leeman M, Warling X . Survey on treatment of hypertension and implementation of World Health Organization/International Society of Hypertension risk stratification in primary care in Belgium. J Hypertens 2002; 20: 1297–1302.

    Article  CAS  Google Scholar 

  2. Hajjar I, Kotchen TA . Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003; 290: 199–206.

    Article  Google Scholar 

  3. Joffres MR, Hamet P, MacLean DR, L'italien GJ, Fodor G . Distribution of blood pressure and hypertension in Canada and the United States. Am J Hypertens 2001; 14: 1099–1105.

    Article  CAS  Google Scholar 

  4. Steyn K, Gaziano TA, Bradshaw D, Laubscher R, Fourie J . Hypertension in South African adults: results from the Demographic and Health Survey, 1998. J Hypertens 2001; 19: 1717–1725.

    Article  CAS  Google Scholar 

  5. van Rossum CT, van de Mheen H, Witteman JC, Hofman A, Mackenbach JP, Grobbee DE . Prevalence, treatment, and control of hypertension by sociodemographic factors among the Dutch elderly. Hypertension 2000; 35: 814–821.

    Article  CAS  Google Scholar 

  6. van Loo JM, Drenthen AJ, Peer PG, Thien TA . Prevalence, case-finding and treatment of hypertension in Lelystad (1982–1984); is the ‘rule of halves’ still applicable? Ned Tijdschr Geneeskd 1987; 131: 624–627.

    CAS  PubMed  Google Scholar 

  7. Anderson KM, Odell PM, Wilson PW, Kannel WB . Cardiovascular disease risk profiles. Am Heart J 1991; 121: 293–298.

    Article  CAS  Google Scholar 

  8. Grobbee DE, Hoes AW, Verheij TJ, Schrijvers AJ, van Ameijden EJ, Numans ME . The Utrecht Health Project: optimization of routine healthcare data for research. Eur J Epidemiol 2005; 20: 285–287.

    Article  Google Scholar 

  9. Steering committee ‘Revision Guideline High Blood pressure’. Revision Guideline High Blood Pressure. Van Zuiden communications BV: Alphen aan den Rijn, 2000, p 146.

  10. Law MR, Wald NJ, Morris JK, Jordan RE . Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003; 326: 1427.

    Article  CAS  Google Scholar 

  11. Banegas JR, Rodriguez-Artalejo F, de la Cruz Troca JJ, Guallar-Castillon P, del Rey CJ . Blood pressure in Spain: distribution, awareness, control, and benefits of a reduction in average pressure. Hypertension 1998; 32: 998–1002.

    Article  CAS  Google Scholar 

  12. Lang T, de Gaudemaris R, Chatellier G, Hamici L, Diene E . Prevalence and therapeutic control of hypertension in 30 000 subjects in the workplace. Hypertension 2001; 38: 449–454.

    Article  CAS  Google Scholar 

  13. Primatesta P, Brookes M, Poulter NR . Improved hypertension management and control: results from the health survey for England 1998. Hypertension 2001; 38: 827–832.

    Article  CAS  Google Scholar 

  14. Psaltopoulou T, Orfanos P, Naska A, Lenas D, Trichopoulos D, Trichopoulou A . Prevalence, awareness, treatment and control of hypertension in a general population sample of 26 913 adults in the Greek EPIC study. Int J Epidemiol 2004; 33: 1345–1352.

    Article  Google Scholar 

  15. Sharma AM, Wittchen HU, Kirch W, Pittrow D, Ritz E, Goke B et al. High prevalence and poor control of hypertension in primary care: cross-sectional study. J Hypertens 2004; 22: 479–486.

    Article  CAS  Google Scholar 

  16. Stein AD, Stoyanovsky V, Mincheva V, Dimitrov E, Hodjeva D, Petkov A et al. Prevalence, awareness, treatment and control of hypertension in a working Bulgarian population. Eur J Epidemiol 2000; 16: 265–270.

    Article  CAS  Google Scholar 

  17. Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA . Gender differences in the utilization of health care services. J Fam Pract 2000; 49: 147–152.

    CAS  PubMed  Google Scholar 

  18. Krousel-Wood M, Thomas S, Muntner P, Morisky D . Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol 2004; 19: 357–362.

    Article  Google Scholar 

  19. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282: 1458–1465.

    Article  CAS  Google Scholar 

  20. van Steenkiste B, van der Weijden T, Stoffers HE, Grol R . Barriers to implementing cardiovascular risk tables in routine general practice. Scand J Prim Health Care 2004; 22: 32–37.

    Article  Google Scholar 

  21. Hagemeister J, Schneider CA, Barabas S, Schadt R, Wassmer G, Mager G et al. Hypertension guidelines and their limitations – the impact of physicians' compliance as evaluated by guideline awareness. J Hypertens 2001; 19: 2079–2086.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the contribution of the general practitioners of the Julius Health Centres Leidsche Rijn: MJC Arnold, NAA Beelen (till 2003), LGM van Berkestijn, CSM Biessels-Oude Elberink, CJ Bijkerk, P Blommendaal, M Buikman, MM van Eenige, J Geurts, MG Giezeman, HE Hart, FJ ten Hove, GJB Hurenkamp, MJJ de Kleijn, JPJM van Langen, CT den Ouden, H Smits-Pelser, TJM Verheij, MM de Vos (2000). Sources of support: The Utrecht Health Project LRGP is supported by grants from the Ministry of Health, Welfare, and Sports (VWS), the University of Utrecht, the Province of Utrecht, the Dutch Organisation of Care Research (ZON), the University Medical Centre of Utrecht (UMC Utrecht) and the Dutch College of Healthcare Insurance Companies (CVZ).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T Scheltens.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scheltens, T., Bots, M., Numans, M. et al. Awareness, treatment and control of hypertension: the ‘rule of halves’ in an era of risk-based treatment of hypertension. J Hum Hypertens 21, 99–106 (2007). https://doi.org/10.1038/sj.jhh.1002123

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1002123

Keywords

This article is cited by

Search

Quick links